Spinal Lesions Question

[Boymom123]

So I have read so much conflicting information about spinal lesions and I am hoping that some of my very educated co-MSers here might be able to help me.

I have a total of 4 lesions - 2 on the brain, one small one (that has shrunk) on my Thoracic spine at T7/T8 and a much smaller lesion on the Thoracic spine a bit lower down (can't remember where). The first small lesion existed when I was first diagnosed. The tiny spinal lesion was there at my last MRI but was older - my doctor believes from prior to the Copaxone getting to full effectiveness. All of my symptoms are sensory (primarily vibrations in my lower body, most of which I have recovered from).

I have heard that spinal lesions are hard to recover from, they predict future walking capabilities etc. Since my symptoms from these lesions are strictly sensory, does that predict my ability to walk in the future? Are they they hard to recover from?

I know I am trying to put some logic around a disease that has no logic, but if you have any insights I would appreciate it.

[jreagan70]

I know I am trying to put some logic around a disease that has no logic, but if you have any insights I would appreciate it.

Since you asked, I have some insights.

First, with an understanding of anatomy and physiology, MS is more logical than not.

Second, there's some unfortunate "slang" circulating out there, and it can hurt rather than help understanding of MS.

So it's important to know and remember what the slang term "lesions on the spine" really means.

MS doesn't involve lesions "on the spine." The spine is part of the skeleton and is made of bone. MS is not a disease of bone. So it's impossible for MS to cause lesions "on the spine."

That unfortunate, slangy terminology is really referring to lesions in the spinal cord. The spinal cord is part of the central nervous system -- made of nerve tissue, not bone -- which is exactly where MS appears.

Medical terminology does refer to spinal lesions vs. brain lesions -- such as Japanese optico-spinal MS, which is believed by many to be neuromyelitis optica -- but that still means spinal cord, not spine, which is, again, bone. And medical terminology does include references to "spinal MS," which refers to a case of MS in which there are more lesions in the spinal cord than in the brain. But that also refers to the spinal cord, not spine, which is, again, bone.

So it's important to remember that that unfortunate term "on the spine" really means "in the spinal cord."

Third, the difference between brain lesions and spinal lesions is the difference in how the brain and spinal cord are put together.

The brain contains billions of nerve cells that have interconnection and redundancy. So if the main lesion is in the brain -- no matter what caused the lesion, be it trauma, a tumor, toxicity, MS or something else -- there are many nerve cells that can interconnect due to plasticity and route the nerve signals around a damaged area, and other parts of the brain can, to some degree, take on the functions of the damaged area.

That's important because, even if the main lesion doesn't heal, other parts of the brain can take over that function and the person can still experience some degree of recovery. That's why it might be said that brain lesions are easier to recover from -- the actual lesion doesn't necessarily have to heal completely for function to return.

In comparison, the spinal cord contains very little redundancy and rerouting. So if the main lesion in the spinal cord doesn't heal, there are no other nerve cells that can route the electrical impulses around the damaged area, so function can't and doesn't come back. That's why it might be said that cord lesions are harder to recover from -- recovery depends on the healing of the actual lesion itself, and that might not happen. That applies equally to motor and sensory nerves.

I have heard that spinal lesions are hard to recover from, they predict future walking capabilities etc. Since my symptoms from these lesions are strictly sensory, does that predict my ability to walk in the future?

If spinal cord lesions affect motor neurons that affect walking, the lack of the ability to reroute can predict walking ability. And the lack of ability to reroute can make spinal cord lesions hard to recover from, since healing depends on how well the lesions itself heals.

Since your symptoms from your spinal cord lesions are strictly sensory, that alone does not predict your ability to walk in the future.

But this nest point is important and worth discussing with your neurologist. Some people never develop spinal cord lesions. And some people have far more cord lesions than brain lesions, which leads to that term I mentioned before, "spinal" MS.

Your neuro will possibly/probably tell you that where MS lesions form is strictly up to chance. And the laws of chance say that that's true. But reality seems to say otherwise. That's why some people have MS that's more sensory than motor, why some people have repeated episodes of optic neuritis while some people never have even a single episode, and why some people never get cord lesions and some people have more cord lesions than brain lesions. There do seem to be individual predilections for where lesions hit.

So, in theory, if you already have spinal cord lesions, your body may continue to form lesions there. And that, in theory -- and not the random chance theory -- increases your odds of developing a cord lesion that affects your motor nerves instead of your sensory nerves. And that increases your chances of developing problems with walking in the future.

But those are only chances, not a prediction that you'll have trouble walking. A prediction of trouble walking would have to wait for you to actually develop a motor lesion in your spinal cord. And that's why you need to talk over your case of MS with your neurologist.

I have read so much conflicting information about spinal lesions

That doesn't make sense to me because the anatomy and physiology of the spinal cord are pretty straightforward. There shouldn't be room for so much conflicting information.

I have to wonder what you've been reading and where. Are you reading trusted, scholarly authority sites, or are you reading message boards and chatroom text, which on the whole have very little credibility ?

[Boymom123]

Thank you JReagan

I know that spinal lesions are not "on the spine" but on the spinal cord. I apologize for using incorrect terminology.

Thank you for explaining spinal cord lesions vs. brain lesions. It makes complete sense what you are saying and actually helps me to better understand what is going on with me personally. To that end, the initial spinal cord lesion that I had seems to be healing. It has shrunken considerably from the previous MRI which I suppose is a good thing.

You are correct in that I haven't read "scientific" journals. I am trying to correct that. I have read conflicting message board posts which led to my question.

I will discuss with my neuro during my visit next month.

[ru4cats]

jreagan70 gave a tremendous explanation of the "mechanics" of MS lesions that I wouldn't want to touch. I can provide some real life effects of lesions on the spine and resulting disability.

When I was diagnosed 5 1/2 years ago like you, I had a few brain lesions but had more on my spinal cord. My first symptom was a "hitch in my get-a-along" that led to the diagnosis of MS 1 1/2 years later. Healing never occurred for the reasons jreagan70 addressed and also due to my age at diagnosis; the progression continues to this day. I went from walking unassisted to walking with trekking poles and eventually had to include an HFAD. 2 1/2 years ago, I added a rollator that I continue to use. I can still walk around the house, but I assume the progression will continue.

With the symptoms you currently have, I wouldn't anticipate a walking disability. However, like jreagan70 said, new lesions create new disability, and age and location determine this disability.

I'm on Tysabri because it severely limits/stops the white cells from crossing the blood brain barrier and attacking the nerve cells. I assume Copaxone does the same, but I've never investigated this drug.

When I was diagnosed, due to my age and location of lesions, my neurologist wanted me on Ty since it still carries the strongest efficacy. I saw her last week for my bi-annual visit, and she still feels this was the right choice for me. However, I am JC-. I consider myself so fortunate I can take this drug.

Best of luck.

[ru4cats]

Boymom123,

I just submitted my reply and then read latest answer. I have learned in my journey with MS that some forums provide more scientifically accurate information than others, and you do need to be careful. For me, this one is the best. I've found the people who belong provide more accurate information and avoid the "drama" that I've found on other forums. "Just the facts, please, just the facts." I do visit others to provide accurate answers to others who haven't migrated here, yet, and I feel are being misled.

[JerryD]

!

jreagan's reply is , as always, accurate and right on point. I don't know about MRI's, I know I have had several taken! I wouldn't trust a message board for medical opinions ! That's foolish ! But jreagen's response is pretty good, I must say ! Good luck

[pennstater]

hi boymom123,

If I recall, I have 4 brain lesions and 8 spinal lesions (c2-c6),2 of which were deemed large (c5,c6). While I have progressed some, my MRIs have been stable for 10 years. I am fortunate. Most of my problems are arm related, aside from fatigue, cognition, and the bouts with dizziness. I am able to walk a few miles at a moderate pace. As long as can keep the fatigue moderate, I get thru ok. If fatigue overwhelms me, I get pseudo exacerbation symptoms: noise/light sensitivity, balance issues, unrelenting dizziness, along with worsening of normal symptoms.

The presence alone of spinal lesions does not predict disability. I have been lucky, as location must be not critical.

Talk to your neuro. Wish you the best.

[Temagami]

Maybe this will give you some hope/breathing room: I was dx´d with spinal lesions affecting both sensory and motor in 2011. The sensory sx will reappear at times, but I have regained the motor and that sx has not returned. Do I worry about mobility? Yes. I have opted out of gluten and all milk products as well as having decreased sugar consumption. Trying to be good about exercising.

[PRW2015]

If I recall, I have 4 brain lesions and 8 spinal lesions (c2-c6),2 of which were deemed large (c5,c6).

What is the definition of "large" in your case?

[pennstater]

If I recall, I have 4 brain lesions and 8 spinal lesions (c2-c6),2 of which were deemed large (c5,c6).

What is the definition of "large" in your case?

To be, honest, I am not sure. I will have to go back and find earliest MRI reports, as the more recent just reference prior "large" lesions since unchanged. Will let you know once I find the old reports.